The Purdue Pegboard: norms for 14- to 19-year-olds

The standardised Malay version of purdue pegboard test: Content validity and test-retest reliability testing

Introduction

Purdue Pegboard Test (PPT) is a valid and reliable instrument for measuring hand dexterity among individuals with or without medical conditions. In the Southeast Asia region where Malay is widely spoken, there is a need to have a Malay translation of Purdue Pegboard Test. This study aimed to translate the PPT into the Malay version (PPT-M) and to determine the content validity and test-retest reliability of this translated version.

Methods

This study involved: (1) four English teachers (translators) for forward and backward translation procedures; (2) 10 experts in the field of occupational therapy (expert reviewers) for content validity testing; and (3) 60 undergraduate students (participants) for test-retest reliability testing.

Results

PPT-M had excellent content validity with Item-Content Validity Index = 0.9-1.0, Scale-Content Validity Index/Average = 0.93-0.95, and a slightly lower Scale-Content Validity Index/Universal Agreement = 0.25-0.75. Test-retest reliability for 3-trial administration (n = 30; Intraclass Correlation Coefficients, ICCs = 0.76-0.85; good) was higher compared to 1-trial administration (n = 30; ICCs = 0.34-0.46; poor) for all subtests. Both trial administrations were mostly affected by systematic errors, especially practice effect as the retests gave higher scores. Random errors mostly affected Subtest 3 of 1-trial administration, evident by its Minimal Detectable Change Percent values = 30.84% that fell beyond the acceptable range.

Conclusion

PPT-M has the potential to be a valuable instrument for measuring hand dexterity among Malay speaking individuals especially when the 3-trial administration is used.

Comparative Analysis of Manual Dexterity of Dental Students at Ajman University following One Academic Year of Preclinical Training Sessions: A Longitudinal Cohort Study

OBJECTIVES

 Dental students must complete two stages of training, namely, preclinical training on phantom head models and clinical training on actual patients to acquire the practical skills required by their Bachelor of Dental Surgery program.Our objectives are to evaluate the level of improvement of the manual skills obtained by third-year dental students after one full academic year of preclinical training courses using dexterity tests under direct and indirect vision and to compare the improvement among male and female dental students under the same conditions.

MATERIALS AND METHODS

 A total of 72 preclinical students participated in our cohort trial, each of whom was assigned a random identification number that was only known to the researchers. After the beginning of the academic year, the experiment was performed under identical conditions for both the O'Connor Tweezer Dexterity Test and the Purdue Pegboard Test. The examinations were conducted at two distinct times: T0 before phantom laboratory training (the beginning of preclinical sessions) and T1 after phantom laboratory training (9 months after T0).

STATISTICAL ANALYSIS

 Signed-rank test of Wilcoxon over two separate periods (T0 and T1), comparisons were made between the direct and indirect visual dexterity test scores. In addition, the Mann-Whitney U test was used to compare results across gender. The statistical significance (p-value) was set at below 0.05 with a confidence level of 95%.

RESULTS

 A statistically significant difference was detected between the T0 and T1 assessments on the Purdue Pegboard Test and the O'Connor Tweezer Dexterity Test for all selected dentistry students in both direct and indirect conditions (p < 0.001).

CONCLUSION

 Further investigation in other dental departments or schools, particularly those with different entry standards, is required prior to making a definitive conclusion about the use of these dexterity assessments as predictors of prospective dental students' performance.

Functional recovery after reduced pediatric fractures of the forearm with respect to perceived limitations, common post-traumatic symptoms, range of motion, and dexterity: a prospective study

PURPOSE

Studies on functional recovery after pediatric forearm fractures are scarce. Outcome measures are usually (retrospectively) incorporated to compare treatments. How these parameters recover has only rarely fallen within the scope. Aim was to provide insight into "normal recovery" by evaluating how limitations, post-traumatic symptoms, range of motion (ROM) and dexterity recuperate.

MATERIALS AND METHODS

Prospective observational study regarding children 4 and 18 years with a reduced forearm fracture. Limitations, post-traumatic symptoms, ROM, and dexterity were evaluated 6 weeks, 3 and 6 months post-trauma. ROM of the unaffected side was used as a baseline.

RESULTS

Of 54 participants 25.9% and 5.9% perceived limitations after 3 respectively 6 months. Pain, swelling and hypertrichosis were common symptoms. Movements distal from the elbow were restrained 6 weeks post-trauma. Supination and palmar flexion were most affected, followed by dorsal flexion and pronation. Palmar flexion and pronation were still affected after 3 months and associated with treatment invasiveness. Dexterity was diminished at 6 weeks only.

CONCLUSIONS

Mild limitations are common. Further investigation of the association between pain, reduced sensitivity and hypertrichosis with treatment invasiveness is warranted. Regarding ROM supination, pronation, palmar and dorsal flexion should be incorporated in future studies. Dexterity is an unsuitable outcome measure.IMPLICATIONS FOR REHABILITATIONThis study relates to monitoring recovery from pediatric forearm fractures.Physicians ought to realize that one in four children experience limitations preceding 3 months post-trauma, in which case involvement of a hand therapist should be considered.Pain, swelling and especially hypertrichosis are common post-traumatic symptoms in children and should on itself not immediately raise concerns for complex regional pain syndrome (CRPS).To assess recovery of range of motion measuring pronation, supination, dorsal, and palmar flexion is sufficient.

Adult norms for the Corbett Targeted Coin Test

STUDY DESIGN

Clinical measurement INTRODUCTION: Dexterity is important for daily activities. The Corbett Targeted Coin Test (CTCT) measures dexterity with palm-to-finger translation and proprioceptive target placement, but lacks established norms.

PURPOSE OF THE STUDY

To establish norms for the CTCT with healthy adult subjects.

METHODS

The inclusion criteria consisted of participants that were community dwelling, non-institutionalized, able to make a fist with both hands, perform finger-to-palm translation of twenty coins, and be at least 18 years of age. CTCT standardized testing procedures were followed. Quality of performance (QoP) scores were determined by speed in seconds and number of coin drops (each a 5-second penalty). QoP was summarized within each age, gender and hand dominance subgroup using the mean, median, minimum, and maximum. Correlation coefficients were computed for relationships between age and QoP, and between handspan and QoP.

RESULTS

Of the 207 individuals who participated, 131 were females and 76 males with an age range of 18-86 and mean age of 37.16. Individual QoP scores ranged from 13.8 to 105.3 seconds, with median scores ranging from 28.7 to 53.3 seconds. The mean for males was 37.5 seconds for the dominant hand (range 15.7-105.3) and 42.3 seconds (range 17.9.-86.8) for the non-dominant hand. The mean for females was 34.7 seconds for the dominant hand (range 14.8-67.0) and 38.6 seconds (range 13.8.-82.7) for the non-dominant hand. Lower QoP scores indicate a faster and/or more accurate dexterity performance. Females showed better median QoP for most age groups. The best median QoP scores were seen in the 30-39 and 40-49 age ranges.

DISCUSSION

Our study agrees to some extent with other research that reported dexterity decreases with age, and increases with smaller hand spans.

CONCLUSION

Normative data for the CTCT can be a guide for clinicians evaluating and monitoring patient dexterity with palm-to-finger translation and proprioceptive target placement.

A longitudinal resource for studying connectome development and its psychiatric associations during childhood

Most psychiatric disorders are chronic, associated with high levels of disability and distress, and present during pediatric development. Scientific innovation increasingly allows researchers to probe brain-behavior relationships in the developing human. As a result, ambitions to (1) establish normative pediatric brain development trajectories akin to growth curves, (2) characterize reliable metrics for distinguishing illness, and (3) develop clinically useful tools to assist in the diagnosis and management of mental health and learning disorders have gained significant momentum. To this end, the NKI-Rockland Sample initiative was created to probe lifespan development as a large-scale multimodal dataset. The NKI-Rockland Sample Longitudinal Discovery of Brain Development Trajectories substudy (N = 369) is a 24- to 30-month multi-cohort longitudinal pediatric investigation (ages 6.0-17.0 at enrollment) carried out in a community-ascertained sample. Data include psychiatric diagnostic, medical, behavioral, and cognitive phenotyping, as well as multimodal brain imaging (resting fMRI, diffusion MRI, morphometric MRI, arterial spin labeling), genetics, and actigraphy. Herein, we present the rationale, design, and implementation of the Longitudinal Discovery of Brain Development Trajectories protocol.

Bimanual performance in children with unilateral perinatal arterial ischaemic stroke or periventricular haemorrhagic infarction

BACKGROUND

Long term outcome data on bimanual performance in children with perinatal arterial ischaemic stroke (PAIS) and periventricular haemorrhagic infarction (PVHI) with and without unilateral spastic cerebral palsy (USCP) is sparse.

AIMS

To assess bimanual performance in children with PAIS or PVHI with and without USCP and to explore the relationship with unilateral hand function and full-scale IQ (FSIQ) in a cross-sectional study.

METHODS

Fifty-two children with PAIS (n = 27) or PVHI (n = 25) participated at a median age of 12 years and 1 month (range 6-20 years). The Bruininks Oseretsky Test of Motor Proficiency-2 (bimanual precision and dexterity subtest), Assisting Hand Assessment, Purdue Pegboard Test and Wechsler Intelligence scale were administered.

RESULTS

Bimanual dexterity was worse in children with USCP (p < 0.02) without a difference for the pathology groups. In children without USCP (n = 21), those with PAIS showed a better bimanual precision compared to children with PVHI (p < 0.04). The AHA score and the Purdue Pegboard score of the dominant hand explained 51% of the variance in bimanual precision and dexterity in children with USCP. In absence of USCP, FSIQ together with AHA scores explained 66% of the variance in bimanual precision and FSIQ together with the Purdue Pegboard Test score of the dominant hand, 71% of the variance in bimanual dexterity.

CONCLUSIONS

Children with PAIS without USCP have a more favourable bimanual hand function compared to children with PVHI. This difference appears to be associated with a preserved FSIQ.

Associations of Motor Performance and Executive Functions: Comparing Children with Down Syndrome to Chronological and Mental Age-Matched Controls

Background. Children with Down syndrome (DS) exhibit lower motor and cognitive performance than typically developing children (TD). Although there is a relationship between these two developmental domains, only a few studies have addressed this association in children with DS compared to groups of the same chronological age (CA) or mental age (MA) within one study. This study aimed to fill this research gap. Method and Procedures. The Movement Assessment Battery for Children-2 and the Trail-Making Test was used to assess motor and cognitive performances in 12 children (M = 10.5 ± 10.08) with DS, 12 CA-matched, and 12 MA-matched controls. Results. There are significant group differences in the motor dimension (total test score; p < 0.001, η²_p = 0.734), for processing speed (p < 0.001, η²_p = 0.396), and cognitive flexibility (p < 0.001, η²_p = 0.498). Between TD-CA and both other groups, the differences in the magnitude of correlations for the motor dimension balance are also significant (compared to DS: z = −2.489; p = 0.006, and to TD-MA: z = −3.12; p < 0.001). Conclusions. Our results suggest that the relationships depend on the studied cognitive and motor skills. It seems crucial to select a wide range of tasks for both domains that are as isolated as possible for future studies, to better understand the relationships between cognitive and motor skills in children with DS.

Manual dexterity and strength and in young adults with and without Attention-Deficit/Hyperactivity Disorder (ADHD)

Manual motor deficits are common in children with attention deficit/hyperactivity disorder (ADHD); however, it is unclear whether these impairments persist into adulthood. The aim of this study was to examine manual dexterity and strength in young adults with ADHD aged 18-25 years. Sixty-one individuals with confirmed ADHD and 56 adults without ADHD completed Purdue Pegboard tasks for manual dexterity and maximal hand- and pinch-grip tests for strength. In the Purdue Pegboard task, participants placed pins using the right, left, and both-hands, respectively. In addition, participants built assemblies using pins, washers, and collars with alternating hand movements. The results demonstrated that women without ADHD out-performed the other three groups in the right-hand, bimanual, and assembly PPB tasks. Both maximal hand strength tests demonstrated that men were stronger than women, but no differences were observed between adults with and without ADHD. The current findings suggest that adults with ADHD may have deficits in manual dexterity and tasks requiring bimanual coordination.

A Prototype of an Electronic Pegboard Test to Measure Hand-Time Dexterity with Impaired Hand Functionality

This paper proposes an electronic prototype of the Grooved Pegboard Test (GPT), which is normally used to test the presence of hand dexterity. The prototype imitates the geometrical dimensions of an on-the-market GPT device, but it is electronic, not manual like the one available now for users. The suggested electronic GPT device makes automated time calculation between placing the first and the last peg in their designated locations, instead of manually observing a stopwatch normally used during the GPT. The electronic GPT prototype consists of a fabricated wooden box, electronics (switches and microcontroller), and liquid crystal display (LCD). A set of 40 normal volunteers, 20 females and 20 males, tested the designed prototype. A set of six volunteers with chronic medical conditions also participated in evaluating the proposed model. The results on normal volunteers showed that the proposed electronic GPT device yielded time calculations that match the population mean value of similar calculations by the GPT device. The one-sample t-test showed no significant difference in calculations between the new electronic GPT and the manual GPT device. The p-value was much higher than 0.05, indicating the possible use of the suggested electronic GPT device.

Temporally resolved neural dynamics underlying handwriting

How do the temporal dynamics of neural activity encode highly coordinated visual-motor behaviour? To capture the millisecond-resolved neural activations associated with fine visual-motor skills, we devised a co-registration system to simultaneously record electroencephalogram and handwriting kinematics while participants were performing four handwriting tasks (writing in Chinese/English scripts with their dominant/non-dominant hand). The neural activation associated with each stroke was clearly identified with a well-structured and reliable pattern. The functional significance of this pattern was validated by its significant associations with language, hand and the cognitive stages and kinematics of handwriting. Furthermore, the handwriting rhythmicity was found to be synchronised to the brain's ongoing theta oscillation, and the synchronisation was associated with the factor of language and hand. These major findings imply an implication between motor skill formation and the interplay between the rhythms in the brain and the peripheral systems.

Motor Imagery Training With Neurofeedback From the Frontal Pole Facilitated Sensorimotor Cortical Activity and Improved Hand Dexterity

To develop a real-time neurofeedback system from the anterior prefrontal cortex (aPFC) using functional near-infrared spectroscopy (fNIRS) for motor rehabilitation, we investigated the effects of motor imagery training with neurofeedback from the aPFC on hand dexterity and cerebral hemodynamic activity during a motor rehabilitation task. Thirty-one right-handed healthy subjects participated in this study. They received motor imagery training six times for 2 weeks under fNIRS neurofeedback from the aPFC, in which they were instructed to increase aPFC activity. The real group subjects (n = 16) were shown real fNIRS neurofeedback signals from the aPFC, whereas the sham group subjects (n = 15) were shown irrelevant randomized signals during neurofeedback training. Before and after the training, hand dexterity was assessed by a motor rehabilitation task, during which cerebral hemodynamic activity was also measured. The results indicated that aPFC activity was increased during the training, and performance improvement rates in the rehabilitation task after the training was increased in the real group when compared with the sham group. Improvement rates of mean aPFC activity across the training were positively correlated with performance improvement rates in the motor rehabilitation task. During the motor rehabilitation task after the training, the hemodynamic activity in the left somatosensory motor-related areas [premotor area (PM), primary motor area (M1), and primary somatosensory area (S1)] was increased in the real group, whereas the hemodynamic activity was increased in the supplementary motor area in the sham group. This hemodynamic activity increases in the somatosensory motor-related areas after the training correlated with aPFC activity during the last 2 days of motor imagery training. Furthermore, improvement rates of M1 hemodynamic activity after the training was positively correlated with performance improvement rates in the motor rehabilitation task. The results suggest that the aPFC might shape activity in the somatosensory motor-related areas to improve hand dexterity. These findings further suggest that the motor imagery training using neurofeedback signals from the aPFC might be useful to patients with motor disability.

Determinants of fine manual dexterity in adolescents and young adults with Down's syndrome

BACKGROUND

To date, numbers of studies have indicated the important role of fine manual dexterity in typical and special populations. However, the relevant studies in Down's syndrome (DS) population is still limited. The purpose of this study was to investigate the determinants of manual dexterity in adolescents and young adults with DS.

METHODS

Thirty participants with DS (22 males, 8 females, aged 13-31) were screened by anthropometric variables (i.e. sex, chronological age, verbal intelligence, body mass index), levels of physical activity, and sleep disorders, and were administered the Purdue Pegboard Test and the Choice Reaction Time Test. Measures of correlation, t-test and multiple regression model were used for data analysis.

RESULTS

It was indicated that sex and sleep-related disorders during the day explained 37.2% of the variance in the performance of the Purdue Pegboard Test. The additional of 9.7% can be explained the variance by adding reaction time test performance. Verbal intelligence had the negatively relation with the performance of non-Dominant Hand and Bimanual subtests of the Purdue Pegboard Test.

CONCLUSION

This study suggested that sex, sleep disorder, and neuromotor function may be the important determinants of fine manual dexterity performance in adolescents and young adults with DS. In addition, the level of intelligence might also exert the effect on fine motor development in this population. In order to design effective interventions and optimize manual performance in individuals with DS, these possible determinants should be considered. Future research should be replicated with large sample size, different age groups, and validated measures of finger size, physical activity and sleep behaviors.

Predicting the clinical performance of dental students with a manual dexterity test

Dentists must be skilled when using dental mirrors. Working with mirrors requires spatial perception, bimanual coordination, perceptual learning and fine motor skills. Many studies have attempted to determine the predictors of manual skills among pre-clinical students, but consensus has yet to be reached. We hypothesized that valid and reliable occupational therapy test performance regarding indirect vision would differ between dental students and junior dentists and would explain the variance in manual skill performance in pre-clinical courses. To test this hypothesis, we applied the Purdue Pegboard test and O’Connor Tweezer Dexterity test under different conditions of direct and indirect vision. We administered these tests to students in phantom-head academic courses in 2015 and 2016 and to junior dentists. Students performed the tests at three time points: before phantom training (T0), at the end of the training (T1) and in the middle of the following year of study (T2). Dentists performed the same tests twice at 1^st and 2^nd trials one week apart. The results showed that indirect tasks were significantly more difficult to perform for both groups. These dexterity tests were sensitive enough to detect students’ improvement after phantom training. The dentists’ performances were significantly better than those of students at T0, specifically with regard to the use of tweezers under direct and indirect vision (the O’Connor test). A regression analysis showed that students’ manual grades obtained at the beginning of the phantom course, their performance on the Purdue test using both hands, and their performance on the O’Connor test under indirect vision predicted phantom course success in 80% of cases. The O’Connor test under indirect vision is the most informative means of monitoring and predicting the manual skills required in the pre-clinical year of dentistry studies.

Factors affecting the results of the functional dexterity test

STUDY DESIGN

Cross-sectional study.

PURPOSE OF THE STUDY

The purpose of this study was to identify which demographic and anthropometric features affect performance (time) on the functional dexterity test (FDT).

METHODS

One hundred fifty-two healthy subjects between the ages of 20 and 80 years were included in this cross-sectional study. Demographic characteristics (age, gender, height, weight, and dominant hand) and anthropometric (the girths of the first 3 fingers) variables were recorded, and the FDT (net time and total score) was performed.

RESULTS

Hand dexterity (time) was slower in participants aged 60 years (35.7 ± 9.4 seconds) and older compared with those aged 40-59 (27.1 ± 7.2 seconds) years and 20-39 (23.9 ± 4.9 seconds) years (P < .001 for both) in dominant side.

DISCUSSION

There was no significant difference between males (29.1 ± 9 in dominant hands and 30.9 ± 9.5 in nondominant hands) and females (27.9 ± 8.4 in dominant hands and 30.8 ± 8.1 in nondominant hands) in all groups in terms of FDT net time. The factors associated with hand dexterity were age in dominant hands (R² = 0.321) and age and thickness of the second and third fingers in nondominant hands (R² = 0.282).

CONCLUSION

FDT scores increased with increasing age for both dominant and nondominant hands. Finger thickness, especially in nondominant hands, should be taken into account while evaluating FDT scores because of its negative effect on dexterity.

LEVEL OF EVIDENCE

Level 2.

Long term longitudinal study of muscle function in patients with glycogen storage disease type IIIa

Glycogen storage disease type III (GSDIII) is an autosomal recessive disorder caused by mutations in the AGL gene coding for the glycogen debranching enzyme. Current therapy is based on dietary adaptations but new preclinical therapies are emerging. The identification of outcome measures which are sensitive to disease progression becomes critical to assess the efficacy of new treatments in upcoming clinical trials. In order to prepare future longitudinal studies or therapeutic trials with large cohorts, information about disease progression is required. In this study we present preliminary longitudinal data of Motor Function Measure (MFM), timed tests, Purdue pegboard test, and handgrip strength collected over 5 to 9years of follow-up in 13 patients with GSDIII aged between 13 and 56years old. Follow-up for nine of the 13 patients was up to 9years. Similarly to our previous cross-sectional retrospective study, handgrip strength significantly decreased with age in patients older than 37years. MFM scores started to decline after the age of 35. The Purdue pegboard score also significantly reduced with increasing age (from 13years of age) but with large inter-visit variations. The time to stand up from a chair or to climb 4 stairs increased dramatically in some but not all patients older than 30years old. In conclusion, this preliminary longitudinal study suggests that MFM and handgrip strength are the most sensitive muscle function outcome measures in GSDIII patients from the end of their third decade. Sensitive muscle outcome measures remain to be identified in younger GSDIII patients but is challenging as muscle symptoms remain discrete and often present as accumulated fatigue.

Bimanual coordination positively predicts episodic memory: A combined behavioral and MRI investigation

Some people remember events more completely and accurately than other people, but the origins of individual differences in episodic memory are poorly understood. One way to advance understanding is by identifying characteristics of individuals that reliably covary with memory performance. Recent research suggests motor behavior is related to memory performance, with individuals who consistently use a single preferred hand for unimanual actions performing worse than individuals who make greater use of both hands. This research has relied on self-reports of behavior. It is unknown whether objective measures of motor behavior also predict memory performance. Here, we tested the predictive power of bimanual coordination, an important form of manual dexterity. Bimanual coordination, as measured objectively on the Purdue Pegboard Test, was positively related to correct recall on the California Verbal Learning Test-II and negatively related to false recall. Furthermore, MRI data revealed that cortical surface area in right lateral prefrontal regions was positively related to correct recall. In one of these regions, cortical thickness was negatively related to bimanual coordination. These results suggest that individual differences in episodic memory may partially reflect morphological variation in right lateral prefrontal cortex and suggest a relationship between neural correlates of episodic memory and motor behavior.

Developmental profile of motor cortex transcallosal inhibition in children and adolescents

Transcallosal fibers facilitate interhemispheric networks involved in motor tasks. Despite their clinical relevance, interhemispheric motor control systems have not been completely defined in the developing brain. The objective of this study was to examine the developmental profile of transcallosal inhibition in healthy children and adolescents. Nineteen typically developing right-handed participants were recruited. Two transcranial magnetic stimulation (TMS) paradigms assessed transcallosal inhibition: ipsilateral silent periods (iSP) and paired-pulse interhemispheric inhibition (IHI). TMS was applied to the motor hotspot of the first dorsal interosseous muscle. Resting motor threshold (RMT), iSP latency, duration and suppression strength, and paired-pulse IHI were measured from both hemispheres. The Purdue Pegboard Test assessed unimanual motor function. Hemispheric differences were evident for RMT and iSP latency and suppression strength, where the left hemisphere had a lower RMT, prolonged latency, and greater suppression strength. iSP duration showed hemispheric symmetry. RMT and iSP latency decreased with age, whereas iSP suppression strength increased. Girls showed shorter iSP latency. Children typically displayed IHI, although hemispheric differences were observed. iSP suppression strength was uniquely associated with IHI within individuals. iSP duration correlated with motor performance. TMS can characterize transcallosal inhibition in normal children and adolescents with effects of age, directionality, sex, and motor performance. Establishing this developmental profile of interhemispheric interactions may advance understanding and therapeutic strategies for pediatric motor disorders such as cerebral palsy.NEW & NOTEWORTHY Here we demonstrate that transcranial magnetic stimulation can characterize transcallosal inhibition in normal children and adolescents with effects of age, directionality, handedness, and motor performance. Interestingly, we also demonstrated sex effects, possibly related to the differing developmental profiles of boys and girls. Establishing this developmental profile of interhemispheric interactions may advance understanding and therapeutic strategies for pediatric motor disorders such as cerebral palsy.

Reference values of manual dexterity using Minnesota Rate of Manipulation Test for Indian adults

Introduction

Dexterity assessment is an integral component of hand function evaluation. The Minnesota Rate of Manipulation Test is a valid and reliable tool to evaluate manual dexterity and has been used to study prognosis of therapy. Information available on its reference values is limited. Reference values are required to interpret, set realistic treatment goals, and assess the ability to return to employment. Therefore, manual dexterity was studied in healthy Indian adults to generate reference values.

Methods

A descriptive study was conducted on 900 subjects divided into three groups: Group 1: 18–30 years ( n = 300): Group 2: 31–60 years (n = 300), and Group 3: ≥61 years ( n = 300). The Minnesota Rate of Manipulation Test was used to evaluate manual dexterity. All subjects performed three trials (one practice + two test trials) of the five subtests. The average of two test trials was used to compute the Minnesota Rate of Manipulation Test score.

Results

The total score of the Minnesota Rate of Manipulation Test in Groups 1, 2, and 3 was 275.7 ± 24.1 s, 299.3 ± 31.9 s, and 357.4 ± 48.6 s, respectively. Manual dexterity was moderately associated with age ( r = 0.707, p < 0.001); however, differences between males and females were nonsignificant ( p = 0.306).

Conclusion

Manual dexterity declined with advancing age; however, differences between genders were not significant. These reference values of manual hand dexterity for healthy adult Indian people will be relevant for clinical assessment of hand function.

Assessment of Activities in Patients with Hand Injury: A Review of Instruments in Use

Physical impairments are not necessarily coupled with functional limitations. For this reason, it is important to assess not only body functions and structures, but also activities and/or participation to decide which intervention is indicated and to evaluate the effect of the intervention in a valid way.

The purpose of this review was to examine available instruments for assessing the limitations in activity and their application within the clinical reasoning process in patients with hand injuries.

A literature search identified instruments that met four selection criteria: quality of information, target population, percentage items related to hand function, and a focus on activities. The selected instruments were categorised according to three items: the specific components, the aspects of activity that could be assessed with it and how activity was assessed (questionnaire or otherwise). Seventy two instruments were identified, of which 23 met the selection criteria. These selected instruments showed important differences in the constructs they assessed and in the manner of assessment.

Instruments to assess limitations of activity as a result of hand injury should be evaluated further in terms of reliability and validity, before their use within the clinical reasoning process can be standardised.

Diurnal Variation in Grip Strength and Hand Dexterity in Healthy Adults

Handgrip and dexterity are integral to hand function and both are used to assess functional status in clinical practice. Many studies have examined the daily fluctuation in handgrip strength with differing conclusions, but none to date have looked at variation in dexterity. This study recruited 30 healthy volunteers and measured their handgrip strength and dexterity using the Nine Hole Peg Test at three-hourly intervals between 9.00am and 4.00pm, over one day. There were statistically significant differences in hand dexterity over the day but not in handgrip strength. Although a possible learning effect from practising a task-specific dexterity assessment such as the Nine Hole Peg Test may explain these findings, the difference was inconsistent and differed between the dominant and non-dominant hand. This study highlights the need for parallel forms of testing hand function to help control for any learning effects and also for therapists to be as constant as possible in the time of day when using functional hand assessments.

Cross-sectional retrospective study of muscle function in patients with glycogen storage disease type III

Glycogen storage disease type III is an inherited metabolic disorder characterized by liver and muscle impairment. This study aimed to identify promising muscle function measures for future studies on natural disease progression and therapeutic trials. The age-effect on the manual muscle testing (MMT), the hand-held dynamometry (HHD), the motor function measure (MFM) and the Purdue pegboard test was evaluated by regression analysis in a cross-sectional retrospective single site study. In patients aged between 13 and 56 years old, the Purdue pegboard test and dynamometry of key pinch and knee extension strength were age-sensitive with annual losses of 1.49, 1.10 and 0.70% of the predicted values (%pred), respectively. The MFM score and handgrip strength were also age-sensitive but only in patients older than 29 and 37 years old with annual losses of 1.42 and 1.84%pred, respectively. Muscle strength assessed by MMT and elbow extension measured by HHD demonstrated an annual loss of less than 0.50%pred and are thus unlikely to be promising outcome measures for future clinical trials. In conclusion, our results identified age-sensitive outcomes from retrospective data and may serve for future longitudinal studies in which an estimation of the minimal number of subjects is provided.

Innovative evaluation of dexterity in pediatrics

STUDY DESIGN

Review paper.

INTRODUCTION

Hand dexterity is multifaceted and essential to the performance of daily tasks. Timed performance and precision demands are the most common features of quantitative dexterity testing. Measurement concepts such as rate of completion, in-hand manipulation and dynamic force control of instabilities are being integrated into assessment tools for the pediatric population.

PURPOSE

To review measurement concepts inherent in pediatric dexterity testing and introduce concepts that are infrequently measured or novel as exemplified with two assessment tools.

METHODS

Measurement concepts included in common assessment tools are introduced first. We then describe seldom measured and novel concepts embedded in two instruments; the Functional Dexterity Test (FDT) and the Strength-Dexterity (SD) Test.

DISCUSSION

The inclusion of novel yet informative tools and measurement concepts in our assessments could aid our understanding of atypical dexterity, and potentially contribute to the design of targeted therapy programs.

Changes in gross grasp strength and fine motor skills in adolescents with pediatric multiple sclerosis

This study examined the gross grasp strength and fine motor dexterity of adolescents, who are diagnosed with multiple sclerosis (MS). A total sample size of 72 participants between the ages of 13 to 17 was studied. Thirty six with a diagnosis of pediatric relapse remitting MS and 36 matched control participants were selected from various local youth groups. Data on hand strength and dexterity was collected using a dynamometer, nine hole peg board and Purdue pegboard on both groups. Utilizing ANCOVA to describe the differences across the two groups by diagnosis, controlling for age and gender, it was found that the MS group demonstrated significantly decreased dexterity when compared to age and gender matched controls. There was no significant difference in gross grasp strength by diagnostic group. This preliminary study showed that children with a diagnosis of pediatric MS may have differences in fine motor dexterity, but not gross grasp strength from their peers who do not have the diagnosis. Further study is indicated to examine this phenomenon.

Use of objective psychomotor tests in health professionals

Evaluation of psychomotor skills is undertaken in a number of broad contexts. This includes testing of health professional populations as a measure of innate ability, to evaluate skill acquisition, or to compare professions. However, the use of psychomotor tests is frequently confounded by a lack of understanding of a particular tool's psychometric properties, strengths, and weaknesses. To identify and appraise the most commonly used tests on health professional populations, 86 articles were reviewed and the top nine tests identified. Few tests have had sufficient validity or reliability testing on health professionals. Based on the evidence available, use of the Grooved Pegboard Test, the Purdue Pegboard Test, or the Finger Tapping Test is recommended for the evaluation of dexterity in a health professional population; however, this choice may be dependent on the task(s) to which findings are generalised. More rigorous evaluation of validity and other psychometric properties is required.

Hand functioning in children with cerebral palsy

Brain lesions may disturb hand functioning in children with cerebral palsy (CP), making it difficult or even impossible for them to perform several manual activities. Most conventional treatments for hand dysfunction in CP assume that reducing the hand dysfunctions will improve the capacity to manage activities (i.e., manual ability, MA). The aim of this study was to investigate the directional relationships (direct and indirect pathways) through which hand skills influence MA in children with CP. A total of 136 children with CP (mean age: 10 years; range: 6–16 years; 35 quadriplegics, 24 diplegics, 77 hemiplegics) were assessed. Six hand skills were measured on both hands: touch-pressure detection (Semmes–Weinstein esthesiometer), stereognosis (Manual Form Perception Test), proprioception (passive mobilization of the metacarpophalangeal joints), grip strength (GS) (Jamar dynamometer), gross manual dexterity (GMD) (Box and Block Test), and fine finger dexterity (Purdue Pegboard Test). MA was measured with the ABILHAND-Kids questionnaire. Correlation coefficients were used to determine the linear associations between observed variables. A path analysis of structural equation modeling was applied to test different models of causal relationships among the observed variables. Purely sensory impairments did seem not to play a significant role in the capacity to perform manual activities. According to path analysis, GMD in both hands and stereognosis in the dominant hand were directly related to MA, whereas GS was indirectly related to MA through its relationship with GMD. However, one-third of the variance in MA measures could not be explained by hand skills. It can be concluded that MA is not simply the integration of hand skills in daily activities and should be treated per se, supporting activity-based interventions.

Hand dexterity in children: administration and normative values of the functional dexterity test

PURPOSE

To document normative values from the Functional Dexterity Test (FTD) for typically developing children and to optimize test administration and interpretation.

METHODS

A total of 175 typically developing children aged 3 to 17 years participated in the study. Children completed the 16-peg FDT with both hands, and elapsed time was recorded in seconds. Data were analyzed as 16/time, interpreted as speed (pegs per second). A linear regression analysis predicted speed from age and hand dominance.

RESULTS

Functional Dexterity Test speed increased linearly in typically developing children by 0.04 pegs/s for each year of age. This rate of increase was the same for dominant and nondominant hands. Dominant hands were faster than nondominant hands by 0.09 pegs/s at all ages. There was no sex difference.

CONCLUSIONS

This study provides age-specific normative values for functional dexterity in typically developing children in 2 formats: as a growth chart of FDT speed versus age and as a regression model that calculates expected speed given a child's age and tested hand dominance. Recommended pediatric modifications to the FDT are to use speed (pegs per second) instead of time (seconds) to report results, and to not assess penalties. The norms presented allow clinicians to compare both speed and rate of change over time of pediatric patients with typically developing children, which makes it possible to distinguish developmental change from intervention.

TYPE OF STUDY/LEVEL OF EVIDENCE

Diagnostic III.

Developmental improvements in dynamic control of fingertip forces last throughout childhood and into adolescence

While it is clear that the development of dexterous manipulation in children exhibits dramatic improvements over an extended period, it is difficult to separate musculoskeletal from neural contributors to these important functional gains. This is in part due to the inability of current methods to disambiguate improvements in hand strength from gains in finger dexterity (i.e., the dynamic control of fingertip force vectors at low magnitudes). We adapted our novel instrumentation to evaluate finger dexterity in 130 typically developing children between the ages of 4 and 16 yr. We find that finger dexterity continues to develop well into late adolescence and musculoskeletal growth and strength are poorly correlated with the improvements in dexterity. Importantly, because these behavioral results seem to mirror the known timelines of neuroanatomical development up to adolescence, we speculate that they reflect the functional benefits of such continual neural maturation. This novel perspective now enables the systematic study of the functional roles of specific neuroanatomical structures and their connectivity, maturity, and plasticity. Moreover, the temporal dynamics of the fingertip force vectors shows improvements in stability that provide a novel way to look at the maturation of finger control. From a clinical perspective, our results provide a practical means to chart functional development of dexterous manipulation in typically developing children and could be adapted for clinical use and for use in children with developmental disorders.

Motor measures: a moving target?

Outcome measures may be used for a variety of reasons by clinicians and researchers. This paper provides an overview on motor measures that can be used in research or practice and are classified within the International Classification of Functioning, Disability and Health or ICF. Specifically, body function measures of neuromusculoskeletal and movement-related functions are presented, as are mobility measures within the activity and participation domain of the ICF. Descriptions of measures within these categories and their psychometric properties are provided. Current challenges and future directions for motor measurement are delineated.

Can noninvasive brain stimulation measure and modulate developmental plasticity to improve function in stroke-induced cerebral palsy?

The permanent nature of motor deficits is a consistent cornerstone of cerebral palsy definitions. Such pessimism is disheartening to children, families, and researchers alike and may no longer be appropriate for it ignores the fantastic plastic potential of the developing brain. Perinatal stroke is presented as the ideal human model of developmental neuroplasticity following distinct, well-defined, focal perinatal brain injury. Elegant animal models are merging with human applied technology methods, including noninvasive brain stimulation for increasingly sophisticated models of plastic motor development following perinatal stroke. In this article, how potential central therapeutic targets are identified and potentially modulated to enhance motor function within these models is discussed. Also, future directions and emerging clinical trials are reviewed.

Modeling developmental plasticity after perinatal stroke: defining central therapeutic targets in cerebral palsy

Perinatal stroke is presented as the ideal human model of developmental neuroplasticity. The precise timing, mechanisms, and locations of specific perinatal stroke diseases provide common examples of well defined, focal, perinatal brain injuries. Motor disability (hemiparetic cerebral palsy) constitutes the primary adverse outcome and the focus of models explaining how motor systems develop in health and after early injury. Combining basic science animal work with human applied technology (functional magnetic resonance imaging, diffusion tensor imaging, and transcranial magnetic stimulation), a model of plastic motor development after perinatal stroke is presented. Potential central therapeutic targets are revealed. The means to measure and modulate these targets, including evidence-based rehabilitation therapies and noninvasive brain stimulation, are suggested. Implications for clinical trials and future directions are discussed.

Relação entre os desempenhos em diferentes testes frequentemente utilizados na avaliação da função manual

INTRODUÇÃO: Testes de Força de Preensão Palmar Máxima (FP Max) e de destreza manual são utilizados como indicativos da função manual . Porém, a FP Max pode ter sua validade questionada, em virtude de raramente exercermos força máxima em tarefas cotidianas. Para investigar a validade da FP Max, examinamos a relação dessa variável com outras obtidas em testes de destreza manual. Ainda, investigamos a relação entre testes de destreza manual. OBJETIVO: Verificar a relação entre a FP Max e o desempenho no Teste de Função Manual de Jebsen e Taylor (TFMJT) e entre o desempenho nesse teste e o desempenho no teste dos Nove Pinos nos Buracos (9-PnB). MÉTODO: Trinta e seis adultos jovens e sadios (18 homens e 18 mulheres) realizaram o TFMJT, seguido do 9-PnB e do teste de FP Max, com ambas as mãos. Foram realizadas análises de correlação entre o desempenho nesses testes. RESULTADOS: Os resultados revelaram a existência de uma relação negativa moderada entre a FP Max e o TFMJT (r < - 0,74), mostrando que, quanto mais forte o indivíduo, menor é o tempo para realizar o TFMJT. Os resultados revelaram, também, uma fraca correlação entre o teste 9-PnB e o TFMJT, somente na mão não dominante. CONCLUSÕES: A FP Max pode ser utilizada como indicativo da FM, mas seus resultados devem ser utilizados com cautela, pois essa variável não contempla todos os aspectos que envolvem a coordenação e o controle das forças atuantes durante a manipulação de objetos. Os testes 9-PnB e TFMJT indicam características diferentes relacionadas às capacidades manipulativas.

Computerized tracking to train dexterity after cerebellar tumour: a single-case experimental study

PRIMARY OBJECTIVE

In a child with pure ataxia after tumour removal, does dexterity training at the right elbow improve dexterity at the right elbow? Does improvement in dexterity transfer to improvement in upper limb activity?

RESEARCH DESIGN

Single-case experimental study with 2-week baseline, 2-week intervention and 2-week follow-up phases and assessment by a blinded assessor.

METHODS AND PROCEDURES

A 5-year old child 3 years after surgical resection of a low-grade cerebellar tumour underwent to dexterity training. Dexterity was measured using a Finger-to-Nose Test and upper limb activity was measured using the 9-Hole Peg Test. Measures were collected every 2 or 3 days over the 6-week period of the study.

RESULTS

Finger-to-Nose Test showed visible but not statistical improvement between baseline and intervention phases in terms of smoothness of movement. On withdrawal of the intervention, visual analysis showed that scores remained at the same level. The 9-Hole Peg Test showed visible but not statistical improvement in terms of speed and smoothness of movement. On withdrawal of the intervention, visual analysis showed that improvement in speed was maintained during follow-up, but smoothness decreased.

CONCLUSIONS

There is some evidence that dexterity can be trained and that improvement carries over to activity.

Development of motor speed and associated movements from 5 to 18 years

AIM

To study the development of motor speed and associated movements in participants aged 5 to 18 years for age, sex, and laterality.

METHOD

Ten motor tasks of the Zurich Neuromotor Assessment (repetitive and alternating movements of hands and feet, repetitive and sequential finger movements, the pegboard, static and dynamic balance, diadochokinesis) were administered to 593 right-handed participants (286 males, 307 females).

RESULTS

A strong improvement with age was observed in motor speed from age 5 to 10, followed by a levelling-off between 12 and 18 years. Simple tasks and the pegboard matured early and complex tasks later. Simple tasks showed no associated movements beyond early childhood; in complex tasks associated movements persisted until early adulthood. The two sexes differed only marginally in speed, but markedly in associated movements. A significant laterality (p<0.001) in speed was found for all tasks except for static balance; the pegboard was most lateralized, and sequential finger movements least. Associated movements were lateralized only for a few complex tasks. We also noted a substantial interindividual variability.

INTERPRETATION

Motor speed and associated movements improve strongly in childhood, weakly in adolescence, and are both of developmental relevance. Because they correlate weakly, they provide complementary information.

Clinimetric evaluation of measurement tools used in hand therapy to assess activity and participation

STUDY DESIGN

Systematic review.

INTRODUCTION

A number of measurement tools with strong clinimetric properties address activities and participation in hand-injured persons.

PURPOSE OF THE STUDY

To evaluate clinimetric quality of measurement tools assessing activities and participation in patients with hand injuries.

METHODS

The electronic databases Medline, Cochrane library, EMBASE, PEDro, Cumulative Index to Nursing and Allied Health Literature (ClNAHL), and Allied and Complementary Medicine Database (AMED) were searched for appropriate literature. Descriptive data of included tools were given, and their clinimetric quality was scored with specific criteria.

RESULTS

The literature search identified 696 publications, referring to 15 measurement tools that met the inclusion criteria. For most of the included tests, applicability was good, whereas information on clinimetric properties was often lacking, especially for the performance tests. Overall, the Disabilities of the Arm, Shoulder, and Hand (DASH) was the most extensively studied tool with positive ratings for all criteria, closely followed by the Michigan Hand Outcomes Questionnaire (MHQ). Of the performance tests, the Functional Dexterity Test (FDT) received the best ratings.

CONCLUSIONS

Optimal measurement tool selection depends highly on the purpose of measurement and the type of hand injury.

LEVEL OF EVIDENCE

2a-.

Reorganization of cortical hand representation in congenital hemiplegia

When damaged perinatally, as in congenital hemiplegia (CH), the corticospinal tract usually undergoes an extensive reorganization, such as the stabilization of normally transient projections to the ipsilateral spinal cord. Whether the reorganization of the corticospinal projections occurring in CH patients is also accompanied by a topographical rearrangement of the hand representations in the primary motor cortex (M1) remains unclear. To address this issue, we mapped, for both hands, the representation of the first dorsal interosseous muscle (1DI) in 12 CH patients by using transcranial magnetic stimulation co-registered onto individual three-dimensional magnetic resonance imaging; these maps were compared with those gathered in age-matched controls (n = 11). In the damaged hemisphere of CH patients, the representation of the paretic 1DI was either found in the hand knob of M1 (n = 5), shifted caudally (n = 5), or missing (n = 2). In the intact hemisphere of six CH patients, an additional, ipsilateral, representation of the paretic 1DI was found in the hand knob, where it overlapped exactly the representation of the non-paretic 1DI. In the other six CH patients, the ipsilateral representation of the paretic 1DI was either shifted caudally (n = 2) or was lacking (n = 4). Surprisingly, in these two subgroups of patients, the representation of the contralateral non-paretic 1DI was found in a more medio-dorsal position than in controls. The present study demonstrates that, besides the well-known reorganization of the corticospinal projections, early brain injuries may also lead to a topographical rearrangement of the representations of both the paretic and non-paretic hands in M1.

The development of a new orthosis (neuro-orthosis) for patients with carpal tunnel syndrome: its effect on the function and strength of the hand

Static wrist orthoses (SWOs) are used in the treatment of carpal tunnel syndrome (CTS) with some drawbacks. As an alternate approach to SWOs, an active closed-loop wrist control strategy based on the principles of functional electrical stimulation was proposed to limit wrist movements. The purpose of the study was to determine whether the proposed 'neuro-orthosis' (NeO) system resulted in less restriction in the hand compared to clinically accepted custom-made SWOs while limiting the wrist movements. A case-control study was designed to determine the specific effects of the system on patients with CTS. A total of 24 right-handed female volunteers (12: CTS, 12: healthy) participated in the study. Function, dexterity, and strengths were measured under three different testing conditions: without orthosis, with SWO, and with the NeO system. Maximum angles in one subtest while the NeO system was on and off and general discomfort levels in SWO and NeO test conditions were recorded. The NeO system resulted in less restriction with respect to SWO and provided considerable angular limitation compared to placebo. It was concluded that the proposed prototype control system can be a good candidate to limit the wrist movements in place of SWOs with a better degree of freedom in patients with CTS.

Corticospinal dysgenesis and upper-limb deficits in congenital hemiplegia: a diffusion tensor imaging study

OBJECTIVES

Precision grasping critically relies on the integrity of the corticospinal tract as evidenced in congenital hemiplegia by the correlation found between corticospinal dysgenesis and hand-movement deficits. Therefore, corticospinal dysgenesis could be used to anticipate upper-limb deficits in young infants with congenital hemiplegia. However, most studies have quantified corticospinal dysgenesis by measuring the cross-sectional area of cerebral peduncles on T1 MRI, a measure biased by other structures present in the peduncles. The purpose of this study was to evaluate the extent to which this may have hampered the conclusions of previous studies. We also aimed to investigate the relationship between upper-limb deficits and a more accurate measure of corticospinal dysgenesis to provide a tool for anticipating upper-limb deficits in infants with congenital hemiplegia.

METHODS

To address this issue, we measured corticospinal tract areas in 12 patients with congenital hemiplegia and 12 matched control subjects by using the diffusion tensor imaging technique. Corticospinal dysgenesis was quantified by computing a symmetry index between the area of the contralateral and ipsilateral corticospinal tracts. This value was then compared with that resulting from the conventional MRI method.

RESULTS

The symmetry indexes gathered with these 2 methods were highly correlated, although the diffusion tensor imaging symmetry indexes were significantly smaller. This indicates that, in patients with congenital hemiplegia, the conventional MRI measurement has led to a systematic underestimate of corticospinal dysgenesis. These 2 estimates of corticospinal dysgenesis were also correlated with upper-limb impairments and disabilities. Although the symmetry index computed from peduncle measurements was correlated solely with deficits in stereognosis, the diffusion tensor imaging index correlated with stereognosis, digital and manual dexterities, and ABILHAND-Kids, a measure of manual ability in daily life activities.

CONCLUSIONS

The diffusion tensor imaging symmetry index provides a useful prognostic tool for anticipating upper-limb deficits and their consequences in daily life activities.

Can pinch grip strength be used as a valid indicator of manual dexterity?

Outcome measurement is important in clinical practice. Manual dexterity is a relevant component of hand function and improvement in dexterity can often be a treatment aim following hand injury. However, standardized dexterity tests can be costly and time consuming to complete in busy clinical practice. Valid, quick and practical clinical indicators of broader functional performance can be a useful adjunct to outcome measurement. This study examined whether tripod pinch grip strength was a valid indicator of manual dexterity.

Thirty healthy volunteers were recruited and their tripod pinch strength was measured using the B+L pinch gauge (B and L Engineering). Manual dexterity was assessed using the Purdue Pegboard.

There were strong, statistically signifi cant correlations between pinch strength and manual dexterity for males but not for females in this healthy sample. Tripod pinch grip could be used as a valid indicator for manual dexterity for males but the relationship between dexterity and pinch grip differs between sexes.

Measuring dexterity in children using the Nine-hole Peg Test

The purpose of this study was to measure dexterity in children aged 4-19 years using the Nine-hole Peg Test. Four hundred and six children were tested with their dominant hand and then their nondominant hand. A commercial version of the Nine-hole Peg Test was used. An analysis of variance showed a main effect for age, gender, and hand dominance. Speed of dexterity improved with age. In all age groups, females performed faster than males. Participants performed faster with the dominant hand than the nondominant hand. The normative data collected provide information for comparing scores to children with different diagnostic categories to screen for fine motor difficulties.

New concepts in managing the long tendons of the thumb after primary repair

This article discusses recent advances in the rehabilitation of injuries of the long flexor and extensor tendons of the thumb, including our own research on this subject. In this field of tendon surgery, we favour a policy of early mobilisation after robust tendon repairs to avoid tethering of the long tendons of the thumb during the early post-operative period. Maintenance of full and rapid movement of the interphalangeal joint of the thumb is vital to the full function of the thumb and is more likely to retained using early mobilisation of tendon repairs.

Analysis of the course of Parkinson's disease under dopaminergic therapy: Performance of ?fast tapping? is not a suitable parameter

In addition to clinical rating scales, instrumental methods are employed frequently for assessment of performance or motor deficits in Parkinson's disease (PD). Many studies have analyzed such parameters in cross-sectional studies. We employed a battery of tests to investigate fine motor performance over a period of 4 years in 411 de novo parkinsonian patients from the Prado study. Specifically, tapping and pegboard testing ("plugging") were evaluated and performance on these tests compared with clinical ratings. Plugging scores correlated well with tapping scores and clinical rating at each assessment timepoint. Both tests also showed significant differences to healthy controls. Nevertheless "fast tapping" was found to be less impaired than was plugging in de novo patients. Over time, it was observed that plugging scores, but not tapping scores, exhibited changes that paralleled movements in clinical score. Plugging scores exhibited a marked response to dopaminergic therapy whereas fast tapping showed no therapeutic response. Fast tapping is certainly not suitable for assessment of bradykinesia or hypokinesia, and does not respond to dopaminergic therapy.

The application of force-sensing resistor sensors for measuring forces developed by the human hand

Most attempts to measure forces developed by the human hand have been implemented by placing force sensors on the object of interaction. Other researchers have placed sensors just on the subject's fingertips. In this paper, a system is described that measures forces over the entire hand using thin-film sensors and associated electronics. This system was developed by the authors and is able to obtain force readings from up to 60 thin-film sensors at rates of up to 400 samples/s per sensor. The sensors can be placed anywhere on the palm and/or fingers of the hand. The sensor readings, together with a video stream containing information about hand posture, are logged into a portable computer using a multiplexer, analogue-to-digital converter and software developed for the purpose. The system has been successfully used to measure forces involved in a range of everyday tasks such as driving a vehicle, lifting saucepans and hitting a golf ball. In the latter case, results are compared with those from an instrumented golf club. Future applications include the assessment of hand strength following disease, trauma or surgery, and to enable quantitative ergonomic investigations.

Double-blind randomized controlled trial of low-level laser therapy in carpal tunnel syndrome

Several studies have suggested that low-level laser therapy (LLLT) is effective in patients with carpal tunnel syndrome (CTS). In a double-blind randomized controlled trial of LLLT, 15 CTS patients, 34 to 67 years of age, were randomly assigned to either the control group (n = 8) or treatment group (n =7). Both groups were treated three times per week for 5 weeks. Those in the treatment group received 860 nm galium/aluminum/arsenide laser at a dosage of 6 J/cm2 over the carpal tunnel, whereas those in the control group were treated with sham laser. The primary outcome measure was the Levine Carpal Tunnel Syndrome Questionnaire, and the secondary outcome measures were electrophysiological data and the Purdue pegboard test. All patients completed the study without adverse effects. There was a significant symptomatic improvement in both the control (P = 0.034) and treatment (P =0.043) groups. However, there was no significant difference in any of the outcome measures between the two groups. Thus, LLLT is no more effective in the reduction of symptoms of CTS than is sham treatment.

Long-latency motor evoked potentials in congenital hemiplegia

OBJECTIVE

To investigate long-latency motor evoked potentials (MEPs) elicited by transcranial magnetic stimulation in congenital hemiplegia (CH) and to seek for correlation with paretic hand movement deficits.

METHODS

MEPs were recorded from the first dorsal interosseous of both hands in 12 CH patients and 12 age-matched controls; dexterity and upper limb function were quantitatively assessed in both groups.

RESULTS

In CH patients, long-latency MEPs, occurring much later than the commonly reported MEPs, were frequently observed in the paretic and non-paretic hands. Four distinct groups of long-latency MEPs were found, each cluster being identified by its mean latency, namely 35, 85, 160 and 225 ms. The residual dexterity of the paretic hand was correlated with the presence of contralateral MEPs with a 20 and 225 ms latency and was negatively correlated with ipsilateral MEPs, irrespective of their latency. In controls, only few MEPs with a latency of 225 ms were found in 4 out of 12 subjects.

CONCLUSIONS

The pattern of MEPs found in CH patients differs dramatically from that reported in adult stroke patients, suggesting that long-latency MEPs are a rather distinctive consequence of early corticospinal lesions. The hypothesis that a given cluster of long-latency MEPs is mediated by a particular pathway appears very unlikely. Rather, we suggest that an exacerbation of cortical and/or spinal excitability is at the origin of these long-latency MEPs.

A homodigital switch flap to restore sensation to the ulnar border of the thumb tip

Three cases of irrevocable loss of sensation on the ulnar side of the thumb tip are presented in which switch of the radial pulp of the thumb tip to the ulnar side restored sensibility to this critical area, providing a useful functional reconstruction.